Attempt review · why, not just what
PGY-1 Internal Medicine · Resident
Tobias reached a diagnosis but missed safety-critical signal — the errors below trace back to unpinned red flags and context.
Each error traced back to the pin decisions that caused it
BecauseNever pinned “Respiratory Rate” and “Oxygen Saturation”, so nothing prompted the dangerous-alternative sweep for this presentation.
Treat Acute coronary syndrome as a must-exclude for this presentation — pin the context that makes it possible, then rule it in or out explicitly.
BecauseNever pinned “Respiratory Rate” and “Oxygen Saturation”, so nothing prompted the dangerous-alternative sweep for this presentation.
Treat Aortic dissection as a must-exclude for this presentation — pin the context that makes it possible, then rule it in or out explicitly.
BecauseDid not pin “Respiratory Rate” and “Oxygen Saturation” as safety red flags before ordering, so stabilisation was not prioritised over diagnosis.
Flag the red flags first and stabilise before pursuing the diagnostic workup.
BecauseReached a plausible diagnosis but crossed a safety boundary in management — a knowledge-vs-action gap rather than a knowledge gap.
Rehearse the safety boundary for this presentation and the safe alternative before committing a plan.
The evidence behind the causal read
Diagnostic clue
Safety red flag
Context factor
Management modifier
Distractor
Submitted vs. expected ranking
| Diagnosis | Expected | Learner | Outcome |
|---|---|---|---|
| Pulmonary embolismWorking diagnosis | #1 | #1 | Correct |
| Acute coronary syndromeCan't-miss | #2 | — | Omitted |
| Aortic dissectionCan't-miss | #4 | — | Omitted |
| Community-acquired pneumoniaReasonable alternative | #3 | #3 | Correct |
| Spontaneous pneumothoraxReasonable alternative | #5 | #5 | Correct |
Pin recall, by intent